下肢骨折在骨伤科中极为常见,因骨的连续性和完整性中断,导致周围软组织损伤,增加了局部张力,阻碍血运及静脉回流,患者会出现局部疼痛、肿胀、畸形及功能障碍,严重影响患者的正常生活,若不及时治疗易使局部肌肉及神经组织等缺血缺氧,将影响骨折折愈合和肢体功能恢复[1 - 2].中医药治疗骨折方法多,效果好,优势明显[ 3].本文观察了中药外敷治疗下肢闭合性骨折的疗效,现将结果报告如下.

目的 分析胫骨干骨折髓内钉内固定手术治疗后并发膝关节痛的原因.方法 回顾性分析2012年5月至2015年5月108例交锁髓内钉内固定治疗胫骨干骨折患者的临床资料.结果 所有患者均得到随访,平均随访时间25.4个月.经髌韧带入路组膝关节疼痛发生率为32.1%,经髌韧带内侧入路组膝关节痛发生率为30%.结论 髌韧带旁入路及髓内钉直径细不能减少术后膝关节痛的发生,小切口及仔细操作可减少疼痛发生率,原因尚需要进一步研究.

目的:探讨肱骨髁间骨折采取尺骨鹰嘴截骨与肱三头肌两侧入路内固定治疗的疗效.方法:收治肱骨髁间骨折患者140例,分为尺骨组(尺骨鹰嘴截骨入路)和肱三头肌组(肱三头肌两侧入路),比较两组治疗效果.结果:在肱三头肌组,术后出血量和康复训练时间明显少于尺骨组;肘关节功能恢复优良率明显高于尺骨组(P<0.05).结论:肱骨髁间骨折采取肱三头肌两侧入路内固定治疗效果优于尺骨鹰嘴截骨入路.

目的 比较关节镜下半月板成形缝合术与半月板切除术对于膝关节半月板损伤的效果. 方法 回顾性分析40例于本院接受手术治疗的单侧膝关节半月板损伤患者,按照人组编号的单双号为原则分为研究组和对照组,各20例.对照组患者给予关节镜下半月板切除术,研究组患者于关节镜下行半月板成形缝合术.比较手术前与手术后6个月两组患者的Lysholm膝关节各项评分及总评分以及两组患者术后6个月恢复的优良率. 结果 手术后6个月,两组患者的Lysholm膝关节各项评分及总评分均较手术前有所提高,但研究组较对照组提高的幅度更大(P＜0.05).术后6个月,研究组的优良率为95％,明显高于对照组的65％ (P＜0.05). 结论 对于膝关节半月板损伤的患者,采用半月板成形术更符合膝关节的生物力学特性,其膝关节功能的保留与恢复均较半月板切除者具有更好的效果.

目的：研究微创小伤口与常规切开复位内固定治疗跟骨关节内骨折的临床效果。方法选取在我院骨科接受治疗的跟骨关节内骨折的患者60例，根据随机分类的方法将其分为小切口组与常规组，小切口组患者30例，常规组患者30例，小切口组采用微创小切口空心钉内固定的方法治疗，常规组采用L型切口切开复位内固定的方法进行治疗，比较两组相关指标。结果小切口组各项指标均优于常规组，<0.05。结论微创小切口与常规切开复位内固定治疗骨折的临床愈合效果比较，微创小切口手术用时短，出血量少，骨折恢复速度快，治疗跟骨关节结内骨折具有比较明显的效果，只得在骨科临床推广。

二分髌骨临床相对少见，常因查体发现，有时伴有外伤，甚至会被误认为髌骨骨折，导致误诊误治。笔者现就二分髌骨的再认识作一综述。

目的：分析经后路加压螺钉内固定治疗胫骨平台后髁劈裂骨折的疗效。方法选取我院收治的50例胫骨平台后髁劈裂骨折患者作为观察组，并将同期收治的50例胫骨平台后髁劈裂骨折患者设为对照组，予以对照组前外侧入路钢板结合拉力螺丝钉内固定治疗；予以观察组经后路加压螺钉内固定治疗，比较两组的临床疗效。结果观察组各项指标均优于对照组，<0.05。结论胫骨平台后髁骨折采取经膝关节后侧入路加压螺钉内固定治疗，疗效显著，遗留创伤小，值得推广。

Objective To investigate the clinical efficacy of three-point puncture combined with controllable balloon percutaneous kyphoplasty (PKP) for treatment of osteoporotic vertebral compression fracture (OVCF).Methods From December 2010 to November 2013,37 OVCF patients with 43 fractured vertebrae were treated with three-point puncture combined with controllable balloon PKP.They were 11 males and 26 females,aged from 56 to 95 years (average 67 years).Clinical efficacy was evaluated and compared by visual analogue scale (VAS) scores and cobb angles in their X-ray films at preoperation,3 days postoperation and final follow-up visit.Results All the PKP operations were successful.The operation time ranged from 25 to 80 minutes (average,40 minutes).The cement injected into each vertebra was from 3 to 4.5 mL (average,3.8 mL).The cement was well distributed in the vertebrae without such complications as nerve injury or cement leakage into the spinal canal.Thirty-six patients with 42 fractured vertebrae were followed up for 3 to 35 months (average,11 months).At 3 days postoperation and final follow-up,the VAS scores were respectively 2.3 ± 0.3 and 1.9 ± 0.2 and the cobb angles were respectively 7.8° ± 0.7° and 8.7° ± 0.8°,significantly improved than those at preoperation (6.9 ± 0.8 and 18.5° ± 6.0°) (P ＜ 0.05).There were no significant differences in VAS score or cobb angle between 3 days postoperation and the final follow-up (P ＞ 0.05).Conclusion Three-point puncture combined with controllable balloon PKP is an efficient treatment for thoracolumbar OVCF.

目的:自行改良经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的工作通道控制球囊扩张方向,并应用其行PKP手术(controllable percutaneous kyphoplasty,C-PKP)治疗胸腰椎骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF),总结其治疗OVCF的优势.方法:将传统经皮椎体后凸成形术的工作通道末端2cm改为边缘圆钝的圆弧状和斜坡状缺口结构,通过调整工作通道方向控制球囊扩张方向.从2010年12月～2013年12月应用其治疗43例胸腰椎OVCF患者,并与同期收治的48例采用PKP治疗的OVCF患者比较.两组患者年龄、性别比、骨折部位、术前疼痛视觉模拟评分(visual analogue scale,VAS)、骨密度和骨折程度比较无统计学差异(P＞0.05),具有可比性.比较两组患者术后3d及术后6个月时的VAS评分、楔形角和后凸角的恢复情况及术后骨水泥渗漏情况.结果:所有患者均顺利完成手术,术中8例发生骨水泥漏,其中C型骨水泥漏6例,B、S型各1例,均发生在传统PKP组,均未出现神经症状及血管栓塞等并发症;C-PKP组骨水泥渗漏发生率低于PKP组,差异有统计学意义(P＜0.05).随访11.3±5.2个月(6～35个月),两组患者术后3d及术后6个月的VAS评分、楔形角及后凸角与术前比较差异均有统计学意义(P＜0.05),两组患者同一时间点的VAS评分、楔形角及后凸角比较差异均无统计学意义(P＞0.05).结论:应用C-PKP治疗胸腰椎OVCF是一种有效方法,可降低骨水泥渗漏的发生率.

Objective To evaluate operative method and outcome through a low midline incision(modified Stoppa) approach in treatment of pelvic and acetabular fractures.Methods All 24 consecutive patients with pelvic or acetabular fracture who were treated with modified Stoppa approach for pelvic or acetabular fracture fixation From Feburary 2008 to March 2012 were retrospectively analyzed.Ten patients were with a pelvic ring injury not involving the acetabular joint and eight patients with a combined fracture,two patients with acetabular fractures were fixed with reconstruction plate.Results Anatomic or satisfactory reduction was achieved in all fractures.The average incision length of the Stoppa was (10.0 ± 1.6) cm (8 to 13 cm),the mean operation time and blood loss were (80 ±15)min (60 to 120 min)and (600 ± 136)ml (300 to 1000 ml) respectively.All cases were followed up 3 to 48months showing satisfactory functional results and no operative complications.All patients satisfied with family life.Conclusions Open reduction and internal fixation of plvic and acetabular fractures through the modified Stoppa approach may have good postoperative radiological and clinical outcomes and have less complications.This is a method of choice for patients with combined trauma with internal organ damage and patients with both side pelvic bone fracture.

<正>跟骨骨折大多数是由于高处坠落伤形成跟距轴向爆力所致,多发生在青壮年。跟骨关节内移位骨折采用保守治疗通常无法恢复正常解剖形态及关节面的平整,常导致跟骨畸形、疼痛、活动功能障碍、外侧撞击等并发症。目前手术治疗跟骨关节内骨折的入路、方法较多,但多采用外侧入路、切开复位内固定的方法[1～3],本次研究应用跟骨锁定板(locking compression plate,LCP),采用外侧扩大"L"形入路切开复位内固定治疗跟骨关节内骨折31例,取得良好效果。报道如下。